title: Continuous hemofiltration in pigs with hyperdynamic septic shock affects cardiac repolarization.
abstract: OBJECTIVE
  Sepsis has been defined as the systemic host response to infection with an overwhelming systemic production of both proinflammatory and anti-inflammatory mediators. Continuous hemofiltration has been suggested as possible therapeutic option that may remove the inflammatory mediators. However, hemodialysis and hemofiltration were reported to influence cardiac electrophysiologic parameters and to increase the arrhythmogenic risk. We hypothesize that sepsis affects electrophysiologic properties of the pig heart and that the effects of sepsis are modified by hemofiltration.
  
  
  METHODS
  Laboratory animal experiments.
  
  
  METHODS
  Animal research laboratory at university medical school.
  
  
  METHODS
  Forty domestic pigs of either gender.
  
  
  METHODS
  In anesthetized, mechanically ventilated, and instrumented pigs sepsis was induced by fecal peritonitis and continued for 22 hours. Conventional or high-volume hemofiltration was applied for the last 10 hours of this period.
  
  
  RESULTS
  Electrocardiogram was recorded before and 22 hours after induction of peritonitis. RR, QT, and QTc intervals were significantly shortened by sepsis. The plasma levels of interleukin-6 and tumor necrosis factor-alpha were increased in sepsis. High-volume hemofiltration blunted the sepsis-induced increase in tumor necrosis factor-alpha. Action potentials were recorded in isolated ventricular tissues obtained at the end of in vivo experiments. Action potential durations were significantly shortened in septic preparations at all stimulation cycle lengths tested. Both conventional and high-volume hemofiltrations lead to further shortening of action potential durations measured afterward in vitro. This action potential duration shortening was reversed by septic hemofiltrates obtained previously by conventional or high-volume hemofiltration. Tumor necrosis factor-alpha (500 ng/L) had no effect on action potential durations in vitro.
  
  
  CONCLUSIONS
  In a clinically relevant porcine model of hyperdynamic septic shock, both sepsis and continuous hemofiltration shortened duration of cardiac repolarization. The continuous hemofiltration was not associated with an increased prevalence of ventricular arrhythmias. Tumor necrosis factor-alpha or interleukin-6 did not contribute to the observed changes in action potential durations.
authors.affiliation: Department of Physiology, Charles University in Prague, Faculty of Medicine and Teaching Hospital in Plzen, Plzen, Czech Republic. milan.stengl@lfp.cuni.cz
authors.forename: Milan
authors.initials: M
authors.lastname: Stengl
authors.forename: Roman
authors.initials: R
authors.lastname: Sykora
authors.forename: Ales
authors.initials: A
authors.lastname: Krouzecky
authors.forename: Jiri
authors.initials: J
authors.lastname: Chvojka
authors.forename: Ivan
authors.initials: I
authors.lastname: Novak
authors.forename: Veronika
authors.initials: V
authors.lastname: Varnerova
authors.forename: Jitka
authors.initials: J
authors.lastname: Kuncova
authors.forename: Lukas
authors.initials: L
authors.lastname: Nalos
authors.forename: Jitka
authors.initials: J
authors.lastname: Sviglerova
authors.forename: Martin
authors.initials: M
authors.lastname: Matejovic
mesh_terms: D000200:Action Potentials; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000517:prevention & control; D004195:Disease Models, Animal; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006439:Hemodynamics; D006440:Hemofiltration; D015850:Interleukin-6 / Q000096:biosynthesis; D008297:Male; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D034421:Sus scrofa; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis; D016276:Ventricular Function
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha